1
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Moore N, Maher M, Murphy G, O'Callaghan Maher M, O'Connor OJ, McEntee MF. CT in the detection of latent tuberculosis: a systematic review. Clin Radiol 2023; 78:568-575. [PMID: 37270335 DOI: 10.1016/j.crad.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/07/2023] [Accepted: 04/23/2023] [Indexed: 06/05/2023]
Abstract
AIM To evaluate the use of computed tomography (CT) and low-dose CT in the detection of latent tuberculosis (TB). MATERIALS AND METHODS A systematic search of literature in adherence with the PRISMA guidelines was carried out. Quality assessment of the included studies was conducted. RESULTS The search strategy identified a total of 4,621 studies. Sixteen studies were considered eligible and included in the review. There was high heterogeneity among all studies. CT was identified as much more sensitive for the detection of latent TB in all studies despite chest radiography often being recommended in guidelines to assess patients for latent TB. Low-dose CT showed promising results in four of the studies; however, these results were limited due to small sample sizes. CONCLUSION CT is much superior to chest radiography consistently identifying additional cases of latent TB. There are limited high-quality publications available using low-dose CT but findings thus far suggest low-dose CT could be used as an alternative to standard-dose CT for the detection of latent TB. It is recommended that a randomised controlled trial investigating low-dose CT should be carried out.
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Affiliation(s)
- N Moore
- Medical Imaging and Radiation Therapy, University College Cork, Ireland.
| | - M Maher
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - G Murphy
- Department of Rheumatology, Cork University Hospital, Cork, Ireland
| | | | - O J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M F McEntee
- Medical Imaging and Radiation Therapy, University College Cork, Ireland
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2
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O'Mahony AT, Henry PJ, Coghlan P, Waldron M, Crowley C, Ryan D, Moore N, Bennett DM, O'Connor OJ, Maher MM, Henry MT. Analytic Morphomics in Myositis-Related Interstitial Lung Disease. Lung 2023; 201:345-353. [PMID: 37458801 PMCID: PMC10444650 DOI: 10.1007/s00408-023-00637-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/04/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE Interstitial lung disease (ILD) is the most common non-musculoskeletal manifestation of idiopathic inflammatory myopathies (IIM). Identification of body composition change may enable early intervention to improve prognosis. We investigated muscle quantity and quality derived from cross-sectional imaging in IIM, and its relationship to ILD severity. METHODS A retrospective cohort study assessing IIM of ILD patients (n = 31) was conducted. Two datasets separated in time were collected, containing demographics, biochemical data, pulmonary function testing and thoracic CT data. Morphomic analysis of muscle quantity (cross-sectional area) and quality (density in Hounsfield Units) on thoracic CT were analysed utilising a web-based tool allowing segmentation of muscle and fat. Bilateral erector spinae and pectoralis muscle (ESM&PM) were measured at defined vertebral levels. RESULTS FVC and DLCO decreased but within acceptable limits of treatment response (FVC: 83.7-78.7%, p < 0.05, DLCO 63.4-60.6%, p < 0.05). The cross-sectional area of the PM and ESM increased (PM: 39.8 to 40.7 cm2, p = 0.491; ESM: 35.2 to 39.5 cm2, p = 0.098). Density significantly fell for both the PM and ESM (PM: 35.3-31 HU, p < 0.05; ESM: 38-33.7, p < 0.05). Subcutaneous fat area increased from 103.9 to 136.1 cm2 (p < 0.05), while the visceral fat area increased but not reaching statistical significance. The change in PM density between time points demonstrated an inverse correlation with DLCO (p < 0.05, R = - 0.49). CONCLUSION Patients with IIM ILD demonstrated significant body composition changes on CT imaging unlikely to be detected by traditional measurement tools. An increase in muscle area with an inverse decrease in density suggests poor muscle quality.
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Affiliation(s)
| | | | - Patrick Coghlan
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Michael Waldron
- Department of Radiology, Cork University Hospital, Cork, Ireland.
- Department of Radiology, University College Cork, Cork, Ireland.
| | - Claire Crowley
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - David Ryan
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Niamh Moore
- Department of Radiography, School of Medicine, University College Cork, Cork, Ireland
| | | | - Owen J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Michael T Henry
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
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3
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Sheahan KP, O'Mahony AT, Morrissy D, Ibrahim H, Crowley C, Waldron MG, Sokol-Randell D, McMahon A, Maher MM, O'Connor OJ, Plant BJ. Replacing Plain Radiograph with ultra-low dose CT thorax in cystic fibrosis (CF) in the era of CFTR modulation and its impact on cumulative effective dose. J Cyst Fibros 2023; 22:715-721. [PMID: 37400300 DOI: 10.1016/j.jcf.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Medical radiation exposure is of increasing concern in patients with cystic fibrosis (PWCF) due to improving life expectancy. We aimed to assess and quantify the cumulative effective dose (CED) in PWCF in the context of CFTR-modulator therapy and the advancement of dose reduction techniques. METHODS We performed a retrospective observational study in a single University CF centre over a 11-year period. We included PWCF, aged over 18 years who exclusively attended our institution. Relevant clinical data (demographics, transplantation history and modulator status) and radiological data (modality, quantity, and radiation exposure measured as CED) were collected. For those on modulator therapy the quantified imaging and radiation data was dichotomised into pre-and-post therapy periods. RESULTS The study included 181 patients: 139 on CFTR modulator therapy, 15 transplant recipients and 27 with neither exposure. 82% of patients received <25 mSv over the study period. Mean study duration was 6.9 ± 2.6 years pre-modulation and 4.2 ± 2.6 years post-modulation. Pre-modulation CT contributed 9.6% of total chest imaging (n = 139/1453) and 70.9% of the total CED. Post-modulation CT use increased contributing 42.7% of chest imaging (n = 444/1039) and comprised 75.8% of CED. Annual CED was 1.55 mSv pre and 1.36 mSv post modulation (p = 0.41). Transplant recipients had an annual CED of 64 ± 36.1mSv. CONCLUSION Chest CT utilisation for PWCF is rising in our institution, replacing chest radiography amidst CFTR-modulation. Despite the increasing use of CT, no significant radiation dose penalty was observed with a reduction in mean annual CED, primarily due to the influence of CT dose reduction strategies.
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Affiliation(s)
- Kevin P Sheahan
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | | | - David Morrissy
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork Ireland
| | - Hisham Ibrahim
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork Ireland
| | - Claire Crowley
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | | | | | - Aisling McMahon
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Barry J Plant
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork Ireland
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4
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O'Mahony AT, Waldron MG, O'Shea S, Mulryan P, O'Connor OJ, Maher MM. Conventional versus ultra-low dose computed tomogram in Crohn's disease: Do morphomics correlate with clinical data? Radiography (Lond) 2023; 29:712-720. [PMID: 37196480 DOI: 10.1016/j.radi.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Cross-sectional study to assess the body composition of patients with Crohn's disease (CD) on standard (SDCT) and low dose CT (LDCT) protocols for the abdomen and pelvis (CTAP). We aimed to assess if a low dose CT protocol reconstructed with model-based iterative reconstruction (IR) could evaluate body morphometric data comparable to standard dose examination. METHODS The CTAP images of 49 patients who underwent a low dose CT scan (20% of standard dose) and a second at standard dose minus 20% were assessed retrospectively. Images were collected from the PACS system, deidentified and analysed using a web-based semi-automated threshold-based segmentation tool (CoreSlicer), capable of identifying tissue type based on differences in attenuation co-efficient. The cross-sectional area (CSA) and Hounsfield units (HU) of each tissue was recorded. RESULTS Muscle and fat CSA is well preserved on comparing these derived metrics from low dose and standard dose CT scans of abdomen and pelvic in CD ((LDCT:SDCT mean CSA (cm2); Psoas muscle - 29.00:28.67, total lumbar muscle - 127.45:125.55, visceral fat- 110.44:114.16, subcutaneous fat - 250.88:255.05)). A fixed difference exists when assessing the attenuation of muscle, with higher attenuation on the low dose protocol (LDCT:SDCT mean attenuation (HU); Psoas muscle - 61.67:52.25, total lumbar muscle - 49.29:41.20). CONCLUSION We found comparable CSA across all tissues (muscle and fat) on both protocols with a strong positive correlation. A marginally lower muscle attenuation suggestive of less dense muscle was highlighted on SDCT. This study augments previous studies suggesting that comparable and reliable morphomic data may be generated from low dose and standard dose CT images. IMPLICATIONS FOR PRACTICE Threshold-based segmental tools can be used to quantify body morphomics on standard and low dose computed tomogram protocols.
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Affiliation(s)
- A T O'Mahony
- Department of Radiology, Cork University Hospital, Cork, T12DC4A, Ireland.
| | - M G Waldron
- Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, Cork, T12AK54, Ireland.
| | - S O'Shea
- Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, Cork, T12AK54, Ireland.
| | - P Mulryan
- Department of Radiology, Cork University Hospital, Cork, T12DC4A, Ireland.
| | - O J O'Connor
- Department of Radiology, Cork University Hospital, Cork, T12DC4A, Ireland; Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, Cork, T12AK54, Ireland.
| | - M M Maher
- Department of Radiology, Cork University Hospital, Cork, T12DC4A, Ireland; Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, Cork, T12AK54, Ireland.
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5
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Coakley S, Young R, Moore N, England A, O'Mahony A, O'Connor OJ, Maher M, McEntee MF. Radiographers' knowledge, attitudes and expectations of artificial intelligence in medical imaging. Radiography (Lond) 2022; 28:943-948. [PMID: 35839662 DOI: 10.1016/j.radi.2022.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Artificial intelligence (AI) is increasingly utilised in medical imaging systems and processes, and radiographers must embrace this advancement. This study aimed to investigate perceptions, knowledge, and expectations towards integrating AI into medical imaging amongst a sample of radiographers and determine the current state of AI education within the community. METHODS A cross-sectional online quantitative study targeting radiographers based in Europe was conducted over ten weeks. Captured data included demographical information, participants' perceptions and understanding of AI, expectations of AI and AI-related educational backgrounds. Both descriptive and inferential statistical techniques were used to analyse the obtained data. RESULTS A total of 96 valid responses were collected. Of these, 64% correctly identified the true definition of AI from a range of options, but fewer (37%) fully understood the difference between AI, machine learning and deep learning. The majority of participants (83%) agreed they were excited about the advancement of AI, though a level of apprehensiveness remained amongst 29%. A severe lack of education on AI was noted, with only 8% of participants having received AI teachings in their pre-registration qualification. CONCLUSION Overall positive attitudes towards AI implementation were observed. The slight apprehension may stem from the lack of technical understanding of AI technologies and AI training within the community. Greater educational programs focusing on AI principles are required to help increase European radiography workforce engagement and involvement in AI technologies. IMPLICATIONS FOR PRACTICE This study offers insight into the current perspectives of European based radiographers on AI in radiography to help facilitate the embracement of AI technology and convey the need for AI-focused education within the profession.
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Affiliation(s)
- S Coakley
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - R Young
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - N Moore
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - A England
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Ireland.
| | - A O'Mahony
- Department of Radiology, Cork University Hospital, Ireland
| | - O J O'Connor
- Department of Radiology, Cork University Hospital, Ireland
| | - M Maher
- Department of Radiology, Cork University Hospital, Ireland
| | - M F McEntee
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Ireland
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6
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Mulryan P, Ni Chleirigh N, O'Mahony AT, Crowley C, Ryan D, McLaughlin P, McEntee M, Maher M, O'Connor OJ. An evaluation of information online on artificial intelligence in medical imaging. Insights Imaging 2022; 13:79. [PMID: 35467250 PMCID: PMC9038977 DOI: 10.1186/s13244-022-01209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/12/2022] [Indexed: 08/24/2023] Open
Abstract
Background Opinions seem somewhat divided when considering the effect of artificial intelligence (AI) on medical imaging. The aim of this study was to characterise viewpoints presented online relating to the impact of AI on the field of radiology and to assess who is engaging in this discourse.
Methods Two search methods were used to identify online information relating to AI and radiology. Firstly, 34 terms were searched using Google and the first two pages of results for each term were evaluated. Secondly, a Rich Search Site (RSS) feed evaluated incidental information over 3 weeks. Webpages were evaluated and categorized as having a positive, negative, balanced, or neutral viewpoint based on study criteria. Results Of the 680 webpages identified using the Google search engine, 248 were deemed relevant and accessible. 43.2% had a positive viewpoint, 38.3% a balanced viewpoint, 15.3% a neutral viewpoint, and 3.2% a negative viewpoint. Peer-reviewed journals represented the most common webpage source (48%), followed by media (29%), commercial sources (12%), and educational sources (8%). Commercial webpages had the highest proportion of positive viewpoints (66%). Radiologists were identified as the most common author group (38.9%). The RSS feed identified 177 posts of which were relevant and accessible. 86% of posts were of media origin expressing positive viewpoints (64%). Conclusion The overall opinion of the impact of AI on radiology presented online is a positive one. Consistency across a range of sources and author groups exists. Radiologists were significant contributors to this online discussion and the results may impact future recruitment. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01209-4.
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Affiliation(s)
- Philip Mulryan
- Cork University Hospital/Mercy University Hospital, Cork, Ireland
| | | | | | - Claire Crowley
- Cork University Hospital/Mercy University Hospital, Cork, Ireland
| | | | | | | | - Michael Maher
- Cork University Hospital/Mercy University Hospital, Cork, Ireland.,University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Cork University Hospital/Mercy University Hospital, Cork, Ireland.,University College Cork, Cork, Ireland
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7
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O'Grady J, Carey BW, Kavanagh RG, O'Connell A, O'Connor OJ, Kenny-Walsh E, Zulquernain SA, Maher MM, Shanahan F. Making computed tomography safer for patients with Crohn's disease. Scand J Gastroenterol 2022; 57:175-182. [PMID: 34699288 DOI: 10.1080/00365521.2021.1994640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and aims: Computed tomography (CT), often more accessible than magnetic resonance imaging (MRI), remains widely used though radiation exposure is an obvious disadvantage. We previously showed that modern CT technology can achieve over 70% reduction in radiation-dose without loss of accuracy. Here, we compare low- versus conventional-dose CT in patients with known Crohn's disease to assess clinical confidence and accuracy of the low-dose procedure in the semi-acute setting.Methods: A comparative study of low-dose CT with full iterative reconstruction (IR) versus conventional-dose CT was conducted in 50 consecutive outpatients with Crohn's disease. Clinicians were provided with the low-dose images and reports, whereas conventional-dose images were reviewed after 4 weeks.Results: The clinical question was adequately addressed with low-dose IR imaging in all cases. Complications of Crohn's were detected in 37/50 (74%) with no disagreement between low- and conventional-dose imaging. The effective radiation dose reduction was 76.5% (low-dose mean 2.15 mSv versus conventional-dose CT 6.99 mSv).Conclusion: Low-dose IR CT is safe and accurate for evaluating distribution and complications of known Crohn's disease in the outpatient setting. We propose that low-dose radiation imaging should be adopted as standard-of-care for the evaluation of Crohn's disease and an acceptable alternative to MR particularly in the acute setting. ClinicalTrials.gov: NCT03140306.
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Affiliation(s)
- John O'Grady
- APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland.,Department of Medicine, Cork University Hospital, Cork, Ireland
| | - Brian W Carey
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | | | | | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Elizabeth Kenny-Walsh
- APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland.,Department of Medicine, Cork University Hospital, Cork, Ireland
| | - Syed A Zulquernain
- APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland.,Department of Medicine, Cork University Hospital, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Fergus Shanahan
- APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland.,Department of Medicine, Cork University Hospital, Cork, Ireland
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8
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Fitzgerald EM, Kavanagh RG, O'Connor OJ, Morrissey DI. Determining the accurate placement of a posterior portal in shoulder arthroscopy with the use of computerized tomography images. JSES Rev Rep Tech 2021; 1:236-241. [PMID: 37588964 PMCID: PMC10426646 DOI: 10.1016/j.xrrt.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Portal placement is an important factor in performing a successful shoulder arthroscopy. Recent cadaveric studies have found variance in the anatomy of the glenohumeral joint. Our aim was to determine if computerized tomography (CT) images could be used to map the trajectory of the posterior portal objectively and then measure the distance between this trajectory and palpable landmarks to apply this knowledge to clinical practice. Methods Two-dimensional multiplanar reformatted CT images were generated using OsiriX (Pixmeo, Switzerland) from CT images performed in a tertiary hospital over a 1-month period. The center of the glenoid was identified and a trajectory through it radiologically mapped. Horizontal and lateral measurements were taken from this trajectory to both the posterolateral edge of the acromion and tip of the coracoid. Results Following application of inclusion and exclusion criteria, 226 shoulders were analyzed. Fifty scans were selected at random and re-reviewed by the primary examiner to assess intra-rater reliability which showed strong correlation and no significant differences between first and second measurements (P < .01, r > 0.6). The mean distance from acromion to portal trajectory was 1.39 cm inferiorly (95% confidence interval [CI] 1.31-1.48, standard deviation [SD] 0.65 cm) and 1.44 cm medially (95% CI 1.35-1.53, SD 0.71 cm). The mean distance from the coracoid to the trajectory was 1.71 cm inferiorly (95% CI 1.64-1.78, SD 0.55 cm) and 1.26 cm medially (95% CI 1-2-1.31, SD 0.45 cm). Paired t-test analysis between right and left shoulders within the same subject, where these data were available (n = 81), showed no significant difference (P > .05) between sides. Subset analysis was also performed between males and females, but only showed a significant difference between the vertical distance from the coracoid process to the center of the glenohumeral joint. This distance was shorter in females compared to males (1.56 cm in females compared to 1.84 cm in males, P < .001). Conclusions Knowledge of shoulder anatomy is vital to the placement of arthroscopic portals, yet research on this topic has been based primarily on surface anatomy, small sample sized cadaveric studies or expert opinion alone. Our study shows that posterior portal placement in shoulder arthroscopy can be measured objectively using CT scanning.
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Affiliation(s)
- Eilis M. Fitzgerald
- Department of Trauma and Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland
| | | | - Owen J. O'Connor
- Senior Lecturer and Consultant Radiologist, Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - David I. Morrissey
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland
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9
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Ryan DJ, Kavanagh RG, Joyce S, O'Callaghan Maher M, Moore N, McMahon A, Hussey D, O'Sullivan MGJ, Wyse G, Fanning N, O'Connor OJ, Maher MM. Development and implementation of an ultralow-dose CT protocol for the assessment of cerebrospinal shunts in adult hydrocephalus. Eur Radiol Exp 2021; 5:26. [PMID: 34180040 PMCID: PMC8236421 DOI: 10.1186/s41747-021-00222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Cerebrospinal fluid shunts in the treatment of hydrocephalus, although associated with clinical benefit, have a high failure rate with repeat computed tomography (CT) imaging resulting in a substantial cumulative radiation dose. Therefore, we sought to develop a whole-body ultralow-dose (ULD) CT protocol for the investigation of shunt malfunction and compare it with the reference standard, plain radiographic shunt series (PRSS). Methods Following ethical approval, using an anthropomorphic phantom and a human cadaveric ventriculoperitoneal shunt model, a whole-body ULD-CT protocol incorporating two iterative reconstruction (IR) algorithms, pure IR and hybrid IR, including 60% filtered back projection and 40% IR was evaluated in 18 adult patients post new shunt implantation or where shunt malfunction was suspected. Effective dose (ED) and image quality were analysed. Results ULD-CT permitted a 36% radiation dose reduction (median ED 0.16 mSv, range 0.07–0.17, versus 0.25 mSv (0.06–1.69 mSv) for PRSS (p = 0.002). Shunt visualisation in the thoracoabdominal cavities was improved with ULD-CT with pure IR (p = 0.004 and p = 0.031, respectively) and, in contrast to PRSS, permitted visualisation of the entire shunt course (p < 0.001), the distal shunt entry point and location of the shunt tip in all cases. For shunt complications, ULD-CT had a perfect specificity. False positives (3/22, 13.6%) were observed with PRSS. Conclusions At a significantly reduced radiation dose, whole body ULD-CT with pure IR demonstrated diagnostic superiority over PRSS in the evaluation of cerebrospinal fluid shunt malfunction. Supplementary Information The online version contains supplementary material available at 10.1186/s41747-021-00222-4.
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Affiliation(s)
- David J Ryan
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland.
| | - Richard G Kavanagh
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Stella Joyce
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | | | - Niamh Moore
- Department of Radiography, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, T12 AK54, Ireland
| | - Aisling McMahon
- Department of Medical Physics, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Deirdre Hussey
- Department of Neurosurgery, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Michael G J O'Sullivan
- Department of Neurosurgery, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Gerald Wyse
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Noel Fanning
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland.,School of Medicine, University College Cork, Cork, Ireland
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10
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Joyce S, Carey BW, Moore N, Mullane D, Moore M, McEntee MF, Plant BJ, Maher MM, O'Connor OJ. Computed tomography in cystic fibrosis lung disease: a focus on radiation exposure. Pediatr Radiol 2021; 51:544-553. [PMID: 33743038 DOI: 10.1007/s00247-020-04706-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/03/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022]
Abstract
Thoracic computed tomography (CT) is the imaging reference method in the diagnosis, assessment and management of lung disease. In the setting of cystic fibrosis (CF), CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography, and findings correlate with clinical outcomes. Better understanding of the aetiology of CF lung disease indicates that even asymptomatic infants with CF can have irreversible pulmonary pathology. Surveillance and early diagnosis of lung disease in CF are important to preserve lung parenchyma and to optimise long-term outcomes. CF is associated with increased cumulative radiation exposure due to the requirement for repeated imaging from a young age. Radiation dose optimisation, important for the safe use of CT in children with CF, is best achieved in a team environment where paediatric radiologists work closely with paediatric respiratory physicians, physicists and radiography technicians to achieve the best patient outcomes. Despite the radiation doses incurred, CT remains a vital imaging tool in children with CF. Radiologists with special interests in CT dose optimisation and respiratory disease are key to the appropriate use of CT in paediatric imaging. Paediatric radiologists strive to minimise radiation dose to children whilst providing the best possible assessment of lung disease.
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Affiliation(s)
- Stella Joyce
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
| | - Brian W Carey
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Niamh Moore
- Department of Radiography, University College Cork, Cork, Ireland
| | - David Mullane
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Michael Moore
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Mark F McEntee
- Department of Radiography, University College Cork, Cork, Ireland
| | - Barry J Plant
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Medicine, Cork University Hospital, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland. .,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland. .,APC Microbiome Institute, University College Cork, Cork, Ireland.
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11
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Simelane T, Ryan DJ, Stoyanov S, Bennett D, McEntee M, Maher MM, O'Tuathaigh CMP, O'Connor OJ. Bridging the divide between medical school and clinical practice: identification of six key learning outcomes for an undergraduate preparatory course in radiology. Insights Imaging 2021; 12:17. [PMID: 33576894 PMCID: PMC7881064 DOI: 10.1186/s13244-021-00971-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There exists a significant divide between what is learnt in medical school and subsequently what is required to practice medicine effectively. Despite multiple strategies to remedy this discordance, the problem persists. Here, we describe the identification of a comprehensive set of learning outcomes for a preparation for practice course in radiology. METHODS Assessment of interns' readiness to interact with the radiology department was conducted using a national survey of both interns and radiologists. In parallel, group concept mapping (GCM) which involves a combination of qualitative and quantitative techniques was used to identify the shared understanding of participants from a diverse range of medical specialties regarding what topics should be included in an intern preparatory course for interacting with the radiology department. RESULTS The survey demonstrated that most interns and radiologists felt that undergraduate medical training did not prepare interns to interact with the radiology department. GCM identified six learning outcomes that should be targeted when designing a preparatory module: requesting investigations; clinical decision support; radiology department IT and communication; adverse reactions and risks; interpretation of radiology results and urgent imaging. The thematic clusters from the group concept mapping corroborated the deficiencies identified in the national survey. CONCLUSION We have identified six key learning outcomes that should be included in a preparation for practice module in radiology. Future courses targeting these thematic clusters may facilitate a smoother transition from theory to practice for newly graduated doctors.
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Affiliation(s)
| | - David J Ryan
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
| | - Slavi Stoyanov
- Open University of the Netherlands, 177, Valkenburgerweg, 6401 DL, Heerlen, The Netherlands
| | - Deirdre Bennett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Mark McEntee
- Department of Radiography, School of Medicine, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
| | - Colm M P O'Tuathaigh
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
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12
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Moloney F, Kavanagh RG, Ronan NJ, Grey TM, Joyce S, Ryan DJ, Moore N, O'Connor OJ, Plant BJ, Maher MM. Ultra-low-dose thoracic CT with model-based iterative reconstruction (MBIR) in cystic fibrosis patients undergoing treatment with cystic fibrosis transmembrane conductance regulators (CFTR). Clin Radiol 2021; 76:393.e9-393.e17. [PMID: 33468311 DOI: 10.1016/j.crad.2020.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023]
Abstract
AIM To assess the utility of a volumetric low-dose computed tomography (CT) thorax (LDCTT) protocol at a dose equivalent to a posteroanterior (PA) and lateral chest radiograph for surveillance of cystic fibrosis (CF) patients. MATERIALS AND METHODS A prospective study was undertaken of 19 adult patients with CF that proceeded to LDCTT at 12 and 24 months following initiation of ivacaftor. A previously validated seven-section, low-dose axial CT protocol was used for the 12-month study. A volumetric LDCTT protocol was developed for the 24-month study and reconstructed with hybrid iterative reconstruction (LD-ASIR) and pure iterative reconstruction (model-based IR [LD-MBIR]). Radiation dose was recorded for each scan. Image quality was assessed quantitatively and qualitatively, and disease severity was assessed using a modified Bhalla score. Statistical analysis was performed and p-values of <0.05 were considered statistically significant. RESULTS Volumetric LD-MBIR studies were acquired at a lower radiation dose than the seven-section studies (0.08 ± 0.01 versus 0.10 ± 0.02 mSv; p=0.02). LD-MBIR and seven-section ASIR images had significantly lower levels of image noise compared with LD-ASIR images (p<0.0001). Diagnostic acceptability scores and depiction of bronchovascular structures were found to be acceptable for axial and coronal LD-MBIR images. LD-MBIR images were superior to LD-ASIR images for all qualitative parameters assessed (p<0.0001). No significant change was observed in mean Bhalla score between 1-year and 2-year studies (p=0.84). CONCLUSIONS The use of a volumetric LDCTT protocol (reconstructed with pure IR) enabled acquisition of diagnostic quality CT images, which were considered extremely useful for surveillance of CF patients, at a dose equivalent to a PA and lateral chest radiograph.
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Affiliation(s)
- F Moloney
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland; Department of Radiology, School of Medicine, University College Cork, Ireland
| | - R G Kavanagh
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland; Department of Radiology, School of Medicine, University College Cork, Ireland
| | - N J Ronan
- Cork Cystic Fibrosis Centre, Cork University Hospital, Wilton, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | - T M Grey
- Department of Radiology, School of Medicine, University College Cork, Ireland
| | - S Joyce
- Department of Radiology, School of Medicine, University College Cork, Ireland.
| | - D J Ryan
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland; Department of Radiology, School of Medicine, University College Cork, Ireland
| | - N Moore
- Department of Radiography, University College Cork, Ireland
| | - O J O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland; Department of Radiology, School of Medicine, University College Cork, Ireland; APC Microbiome, University College Cork, Ireland
| | - B J Plant
- Cork Cystic Fibrosis Centre, Cork University Hospital, Wilton, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | - M M Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland; Department of Radiology, School of Medicine, University College Cork, Ireland; APC Microbiome, University College Cork, Ireland
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13
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Joyce S, O'Connor OJ, Maher MM, McEntee MF. Strategies for dose reduction with specific clinical indications during computed tomography. Radiography (Lond) 2020; 26 Suppl 2:S62-S68. [PMID: 32682731 DOI: 10.1016/j.radi.2020.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022]
Abstract
Increasing integration of computed tomography (CT) into routine patient care has escalated concerns regarding associated radiation exposure. Specific patient cohorts, particularly those with cystic fibrosis (CF) and Crohn's disease, have repeat exposures and thus have an increased risk of high lifetime cumulative effective dose exposures. Thoracic CT is the gold standard imaging method in the diagnosis, assessment and management of pulmonary disease. In the setting of CF, CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography. Furthermore, in specific cases of Crohn's disease, CT demonstrates diagnostic superiority over magnetic resonance imaging (MRI) for radiological evaluation. Low dose CT protocols have proven beneficial in the evaluation of CF, Crohn's disease and renal calculi, and in the follow up of testicular cancer patients. For individuals with chronic conditions warranting frequent radiological follow up, the focus must continue to be the incorporation of appropriate CT use into patient care. This is of particular importance for the paediatric population who are most susceptible to potential radiation induced malignancy. CT technological developments continue to focus on radiation dose optimisation. This article aims to highlight these advancements, which prioritise the acquisition of diagnostically satisfactory images with the least amount of radiation possible.
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Affiliation(s)
- S Joyce
- Department of Radiology, University College Cork, Cork, Ireland.
| | - O J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M M Maher
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M F McEntee
- Discipline of Diagnostic Radiography, University College Cork, Cork, Ireland
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14
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Moloney F, Twomey M, James K, Kavanagh RG, Fama D, O'Neill S, Grey TM, Moore N, Murphy MJ, O'Connor OJ, Maher MM. A phantom study of the performance of model-based iterative reconstruction in low-dose chest and abdominal CT: When are benefits maximized? Radiography (Lond) 2019; 24:345-351. [PMID: 30292504 DOI: 10.1016/j.radi.2018.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/26/2018] [Accepted: 04/23/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The aim of this study was to assess and compare the effects of CT image reconstruction techniques on low-dose CT image quality using phantoms. METHODS Anthropomorphic torso and spatial/contrast-resolution phantoms were scanned at decreasing tube currents between 400 and 10 mA. CT thorax and abdomen/pelvis series were reconstructed with filtered back projection (FBP) alone, combined 40% adaptive statistical iterative reconstruction & FBP (ASIR40), and model-based iterative reconstruction (MBIR) [(resolution-preference 05 (RP05) and RP20 in the thorax and RP05 and noise-reduction 05 (NR05) in the abdomen)]. Two readers rated image quality quantitatively and qualitatively. RESULTS In thoracic CT, objective image noise on MBIR RP05 data sets outperformed FBP at 200, 100, 50 and 10 mA and outperformed ASIR40 at 50 and 10 mA (p < 0.001). MBIR RP20 outperformed FBP at 50 and 10 mA and outperformed ASIR40 at 10 mA (p < 0.001). Compared with both FBP and ASIR40, MBIR RP05 demonstrated significantly better signal-to-noise ratio (SNR) at 10 mA. In abdomino-pelvic CT, MBIR RP05 and NR05 outperformed FBP and ASIR at all tube current levels for objective image noise. NR05 demonstrated greater SNR at 200, 100, 50 and 10 mA and RP05 demonstrated greater SNR at 50 and 10 mA compared with both FBP and ASIR. MBIR images demonstrated better subjective image quality scores. Spatial resolution, low-contrast detectability and contrast-to-noise ratio (CNR) were comparable between image reconstruction techniques. CONCLUSION CTs reconstructed with MBIR have lower image noise and improved image quality compared with FBP and ASIR. These effects increase with reduced radiation exposure confirming optimal use for low-dose CT imaging.
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Affiliation(s)
- F Moloney
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - M Twomey
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - K James
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - R G Kavanagh
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland.
| | - D Fama
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - S O'Neill
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - T M Grey
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - N Moore
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland
| | - M J Murphy
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - O J O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland; APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - M M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland; College of Medicine & Health, University College Cork, Cork, Ireland; APC Microbiome Ireland, University College Cork, Cork, Ireland
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15
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O'Neill S, Kavanagh RG, Carey BW, Moore N, Maher M, O'Connor OJ. Using body mass index to estimate individualised patient radiation dose in abdominal computed tomography. Eur Radiol Exp 2018; 2:38. [PMID: 30483977 PMCID: PMC6258803 DOI: 10.1186/s41747-018-0070-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The size-specific dose estimate (SSDE) is a dose-related metrics that incorporates patient size into its calculation. It is usually derived from the volume computed tomography dose index (CTDIvol) by applying a conversion factor determined from manually measured anteroposterior and lateral skin-to-skin patient diameters at the midslice level on computed tomography (CT) localiser images, an awkward, time-consuming, and not highly reproducible technique. The objective of this study was to evaluate the potential for the use of body mass index (BMI) as a size-related metrics alternative to the midslice effective diameter (DE) to obtain a size-specific dose (SSDE) in abdominal CT. METHODS In this retrospective study of patients who underwent abdominal CT for the investigation of inflammatory bowel disease, the DE was measured on the midslice level on CT-localiser images of each patient. This was correlated with patient BMI and the linear regression equation relating the quantities was calculated. The ratio between the internal and the external abdominal diameters (DRATIO) was also measured to assess correlation with radiation dose. Pearson correlation analysis and linear regression models were used. RESULTS There was good correlation between DE and patient BMI (r = 0.88). An equation allowing calculation of DE from BMI was calculated by linear regression analysis as follows: DE = 0.76 (BMI) + 9.4. A weak correlation between radiation dose and DRATIO was demonstrated (r = 0.45). CONCLUSIONS Patient BMI can be used to accurately estimate DE, obviating the need to measure anteroposterior and lateral diameters in order to calculate a SSDE for abdominal CT.
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Affiliation(s)
- Siobhan O'Neill
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, University College Cork, Cork, Ireland
| | - Richard G Kavanagh
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland. .,Department of Radiology, University College Cork, Cork, Ireland.
| | - Brian W Carey
- Department of Radiology, University College Cork, Cork, Ireland
| | - Niamh Moore
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, University College Cork, Cork, Ireland.,APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, University College Cork, Cork, Ireland.,APC Microbiome Ireland, University College Cork, Cork, Ireland
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16
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O'Brien S, Kavanagh RG, Carey BW, Maher MM, O'Connor OJ, Andrews EJ. The impact of sarcopenia and myosteatosis on postoperative outcomes in patients with inflammatory bowel disease. Eur Radiol Exp 2018; 2:37. [PMID: 30460523 PMCID: PMC6246753 DOI: 10.1186/s41747-018-0072-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) is a relatively common disorder with significant associated morbidity. Sarcopenia and myosteatosis are associated with adverse postoperative outcomes. This study investigated outcomes in IBD patients undergoing surgical resection relative to the presence of sarcopenia and myosteatosis. Methods A retrospective analysis of a prospectively maintained surgical database was conducted. All patients undergoing elective or emergency resection for IBD between 2011 and 2016, with a contemporaneous perioperative computed tomography (CT) scan, were included. Patient demographics, clinical and biochemical measurements were collected. Skeletal muscle index and attenuation were measured on perioperative CT scans using Osirix version 5.6.1. Univariate and multivariate regression analysis was used to identify risk factors for adverse postoperative outcomes. Results Seventy-seven patients (46 male, 31 female; mean age 42 years, range 20–80 years) were included. Thirty patients (30%) had sarcopenia and 26 (34%) had myosteatosis. Myosteatosis was significantly associated with increased hospital stay postoperatively (9 versus 13 days). Sarcopenia and myosteatosis were associated with hospital readmission within 30 days on univariate analysis. Multivariate regression analysis demonstrated an independent association between myosteatosis and hospital readmission. Sixteen patients (21%) had a clinically relevant postoperative complication, but an association with sarcopenia and myosteatosis was not observed. A neutrophil-lymphocyte ratio greater than 5 was predictive of clinically relevant postoperative complications on multivariate regression analysis. Conclusions Myosteatosis was associated with increased hospital stay and increased 30-day hospital readmission rates on multivariate regression analysis. Sarcopenia and myosteatosis in IBD were not associated with clinically relevant postoperative complications.
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Affiliation(s)
- Stephen O'Brien
- The Hiram C. Polk Jr., MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, USA.,Department of Surgery, Cork University Hospital, Cork, Ireland
| | | | - Brian W Carey
- Department of Radiology, Cork University Hospital, Cork, Ireland.
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland.,Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland.,Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland
| | - Emmet J Andrews
- Department of Surgery, Cork University Hospital, Cork, Ireland
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17
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Balta JY, Twomey M, Moloney F, Duggan O, Murphy KP, O'Connor OJ, Cronin M, Cryan JF, Maher MM, O'Mahony SM. A comparison of embalming fluids on the structures and properties of tissue in human cadavers. Anat Histol Embryol 2018; 48:64-73. [PMID: 30450564 DOI: 10.1111/ahe.12412] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 12/11/2022]
Abstract
Cadaveric material has long been used to teach anatomy and more recently to train students in clinical skills. The aim of this study was to develop a systematic approach to compare the impact of four embalming solutions on the tissues of human cadavers. To this end, a formalin-based solution, Thiel, Genelyn and Imperial College London soft-preservation (ICL-SP) solution were compared. The effect of these chemicals on the properties of the tissue was assessed by measuring the range of motion (ROM) of joints and measuring the dimensions of different structures on computed tomography (CT) images before and after embalming. The mean changes in the ratio (angle to ROM) differed statistically between embalming methods (Welch Statistic 3,1.672 = 67.213, p = 0.026). Thiel embalmed cadavers showed an increase in range of motion while ICL-SP cadavers remained relatively the same. Genelyn and formalin embalmed cadavers registered a notable decrease in range of motion. Furthermore, investigation into the impact of the embalming chemicals on the dimensions of internal organs and vessels revealed that Thiel embalming technique leads to a decrease in the dimension of the cardiovascular system alone while formalin-based solutions maintain the shape of the organs and vessels investigated. Our findings suggest that the joints of cadavers' embalmed using ICL-SP technique may faithfully mimic that of unembalmed cadavers and that formalin is necessary to retain shape and size of the organs and vessels investigated in this study. Despite this, a study with larger numbers of cadavers is required to confirm these findings.
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Affiliation(s)
- Joy Y Balta
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Fiachra Moloney
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Orla Duggan
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Ireland
| | - Kevin P Murphy
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Michael Cronin
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - John F Cryan
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Siobhain M O'Mahony
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
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18
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Moloney F, James K, Twomey M, Ryan D, Grey TM, Downes A, Kavanagh RG, Moore N, Murphy MJ, Bye J, Carey BW, McSweeney SE, Deasy C, Andrews E, Shanahan F, Maher MM, O'Connor OJ. Low-dose CT imaging of the acute abdomen using model-based iterative reconstruction: a prospective study. Emerg Radiol 2018; 26:169-177. [PMID: 30448900 DOI: 10.1007/s10140-018-1658-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/09/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Performance of a modified abdominopelvic CT protocol reconstructed using full iterative reconstruction (IR) was assessed for imaging patients presenting with acute abdominal symptoms. MATERIALS AND METHODS Fifty-seven patients (17 male, 40 female; mean age of 56.5 ± 8 years) were prospectively studied. Low-dose (LD) and conventional-dose (CD) CTs were contemporaneously acquired between November 2015 and March 2016. The LD and CD protocols imparted radiation exposures approximating 10-20% and 80-90% those of routine abdominopelvic CT, respectively. The LD images were reconstructed with model-based iterative reconstruction (MBIR), and CD images with hybrid IR (40% adaptive statistical iterative reconstruction (ASIR)). Image quality was assessed quantitatively and qualitatively. Independent clinical interpretations were performed with a 6-week delay between reviews. RESULTS A 74.7% mean radiation dose reduction was achieved: LD effective dose (ED) 2.38 ± 1.78 mSv (size-specific dose estimate (SSDE) 3.77 ± 1.97 mGy); CD ED 7.04 ± 4.89 mSv (SSDE 10.74 ± 5.5 mGy). LD-MBIR images had significantly lower objective and subjective image noise compared with CD-ASIR (p < 0.0001). Noise reduction for LD-MBIR studies was greater for patients with BMI < 25 kg/m2 than those with BMI ≥ 25 kg/m2 (5.36 ± 3.2 Hounsfield units (HU) vs. 4.05 ± 3.1 HU, p < 0.0001). CD-ASIR studies had significantly better contrast resolution, and diagnostic acceptability (p < 0.0001 for all). LD-MBIR studies had significantly lower streak artifact (p < 0.0001). There was no difference in sensitivity for primary findings between the low-dose and conventional protocols with the exception of one case of enteritis. CONCLUSIONS Low-dose abdominopelvic CT performed with MBIR is a feasible radiation dose reduction strategy for imaging patients presenting with acute abdominal pain.
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Affiliation(s)
- Fiachra Moloney
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Karl James
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - David Ryan
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Tyler M Grey
- School of Medicine, University College Cork, Cork, Ireland
| | - Amber Downes
- School of Medicine, University College Cork, Cork, Ireland
| | - Richard G Kavanagh
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Niamh Moore
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Mary Jane Murphy
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | | | - Brian W Carey
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland.
| | - Sean E McSweeney
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - Emmett Andrews
- Department of Surgery, Cork University Hospital, University College Cork, Cork, Ireland
| | - Fergus Shanahan
- Department of Medicine, Cork University Hospital, University College Cork, Cork, Ireland.,Alimentary Pharmabiotic Center, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland.,Alimentary Pharmabiotic Center, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland.,Alimentary Pharmabiotic Center, Cork, Ireland
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19
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O'Brien S, Twomey M, Moloney F, Kavanagh RG, Carey BW, Power D, Maher MM, O'Connor OJ, Ó'Súilleabháin C. Sarcopenia and Post-Operative Morbidity and Mortality in Patients with Gastric Cancer. J Gastric Cancer 2018; 18:242-252. [PMID: 30276001 PMCID: PMC6160525 DOI: 10.5230/jgc.2018.18.e25] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/12/2018] [Accepted: 07/30/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose Surgical resection for gastric adenocarcinoma is associated with significant post-operative morbidity and mortality. The aim of this study was to assess the prognostic significance of sarcopenia in patients undergoing resection for gastric adenocarcinoma with respect to post-operative morbidity and survival. Materials and Methods A retrospective analysis was conducted on a cohort of consecutive patients who underwent surgical resection for gastric adenocarcinoma between 2008 and 2014. Patient demographics, radiological parameters, and pathological data were collected. OsiriX software (Pixmeo) was used to measure skeletal muscle area, which was normalized for height to calculate skeletal muscle index. Results A total of 56 patients (41 male, 15 female; mean age, 68.4 ± 11.9 years) met the inclusion criteria. Of these, 36% (20 of 56) of the patients were sarcopenic pre-operatively. Both sarcopenic and non-sarcopenic patient groups were equally matched with the exception of weight and body mass index (P=0.036 and 0.001, respectively). Sarcopenia was associated with a decreased overall survival (log-rank P=0.003) and was an adverse prognostic predictor of overall survival in multivariate analysis (hazard ratio, 10.915; P=0.001). Sarcopenia was a predictor of serious in-hospital complications in multivariate analysis (odds ratio, 3.508; P=0.042). Conclusions In patients undergoing curative resection for gastric cancer, there was a statistically significant association between sarcopenia and both decreased overall survival and serious post-operative complications. The measurement and reporting of skeletal muscle index on pre-operative computed tomography should be considered.
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Affiliation(s)
- Stephen O'Brien
- Department of Surgery, Mercy University Hospital, Cork, Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Fiachra Moloney
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | | | - Brian W Carey
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Derek Power
- Department of Medical Oncology, Mercy Cork University Hospitals, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
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Moloney F, Twomey M, Fama D, Balta JY, James K, Kavanagh RG, Moore N, Murphy MJ, O'Mahony SM, Maher MM, Cryan JF, O'Connor OJ. Determination of a suitable low-dose abdominopelvic CT protocol using model-based iterative reconstruction through cadaveric study. J Med Imaging Radiat Oncol 2018; 62:625-633. [PMID: 29656596 DOI: 10.1111/1754-9485.12733] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/08/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cadaveric studies provide a means of safely assessing new technologies and optimizing scanning prior to clinical validation. Reducing radiation exposure in a clinical setting can entail incremental dose reductions to avoid missing important clinical findings. The use of cadavers allows assessment of the impact of more substantial dose reductions on image quality. Our aim was to identify a suitable low-dose abdominopelvic CT protocol for subsequent clinical validation. METHODS Five human cadavers were scanned at one conventional dose and three low-dose settings. All scans were reconstructed using three different reconstruction algorithms: filtered back projection (FBP), hybrid iterative reconstruction (60% FBP and 40% adaptive statistical iterative reconstruction (ASIR40)), and model-based iterative reconstruction (MBIR). Two readers rated the image quality both quantitatively and qualitatively. RESULTS Model-based iterative reconstruction images had significantly better objective image noise and higher qualitative scores compared with both FBP and ASIR40 images at all dose levels. The greatest absolute noise reduction, between MBIR and FBP, of 34.3 HU (equating to a 68% reduction) was at the lowest dose level. MBIR reduced image noise and improved image quality even in CT images acquired with a mean radiation dose reduction of 62% compared with conventional dose studies reconstructed with ASIR40, with lower levels of objective image noise, superior diagnostic acceptability and contrast resolution, and comparable subjective image noise and streak artefact scores. CONCLUSION This cadaveric study demonstrates that MBIR reduces image noise and improves image quality in abdominopelvic CT images acquired with dose reductions of up to 62%.
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Affiliation(s)
- Fiachra Moloney
- Department of Radiology, Cork University Hospital, Cork, Ireland.,Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, Cork, Ireland.,Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Daniel Fama
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Joy Y Balta
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Karl James
- Department of Radiology, Cork University Hospital, Cork, Ireland.,Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Richard G Kavanagh
- Department of Radiology, Cork University Hospital, Cork, Ireland.,Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Niamh Moore
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Mary Jane Murphy
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Siobhan M O'Mahony
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland.,Alimentary Pharmabiotic Centre Microbiome Ireland, University College Cork, Cork, Ireland
| | - John F Cryan
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland.,Alimentary Pharmabiotic Centre Microbiome Ireland, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland.,Alimentary Pharmabiotic Centre Microbiome Ireland, University College Cork, Cork, Ireland
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21
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Acton H, James K, Kavanagh RG, O'Tuathaigh C, Moloney D, Wyse G, Fanning N, Maher M, O'Connor OJ. Monitoring neurointerventional radiation doses using dose-tracking software: implications for the establishment of local diagnostic reference levels. Eur Radiol 2018; 28:3669-3675. [PMID: 29651772 DOI: 10.1007/s00330-018-5405-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/10/2018] [Accepted: 02/22/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is potential for high radiation exposure during neurointerventional procedures. Increasing regulatory requirements mandate dose monitoring of patients and staff, and justification of high levels of radiation exposure. This paper demonstrates the potential to use radiation dose-tracking software to establish local diagnostic reference levels. METHODS Consecutive neurointerventional procedures, performed in a single institution within a one-year period, were retrospectively studied. Dose area product (DAP) data were collected using dose-tracking software and clinical data obtained from a prospectively generated patient treatment database. RESULTS Two hundred and sixty-four procedures met the selection criteria. Median DAP was 100 Gy.cm2 for aneurysm coiling procedures, 259 Gy.cm2 for arteriovenous malformation (AVM) embolisation procedures, 87 Gy.cm2 for stroke thrombolysis/thrombectomy, and 74 Gy.cm2 for four-vessel angiography. One hundred and nine aneurysm coiling procedures were further studied. Six significant variables were assessed using stepwise regression analysis to determine effect on DAP. Aneurysm location (anterior vs posterior circulation) had the single biggest effect (p = 0.004). CONCLUSIONS This paper confirms variable radiation exposures during neurointerventional procedures. The 75th percentile (used to define diagnostic reference levels) of DAP measurements represents a reasonable guidance metric for monitoring purposes. Results indicate that aneurysm location has the greatest impact on dose during coiling procedures and that anterior and posterior circulation coiling procedures should have separate diagnostic reference levels. KEY POINTS • Dose-tracking software is useful for monitoring patient radiation dose during neurointerventional procedures • This paper provides a template for methodology applicable to any interventional suite • Local diagnostic reference levels were defined by using the 75th percentile of DAP as per International Commission on Radiological Protection recommendations • Aneurysm location is the biggest determinant of radiation dose during coiling procedures. • Anterior and posterior circulation coiling procedures should have separate diagnostic reference levels.
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Affiliation(s)
- Holly Acton
- School of Medicine, University College Cork, Cork, Ireland
| | - Karl James
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Richard G Kavanagh
- School of Medicine, University College Cork, Cork, Ireland. .,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
| | | | - Deirdre Moloney
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Gerald Wyse
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Noel Fanning
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael Maher
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Owen J O'Connor
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
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22
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O'Neill S, Glynn D, Murphy KP, James K, Twomey M, Kavanagh R, O'Connor OJ, Maher MM. An Assessment of the Quality of CT Radiation Dose Information on the Internet. J Am Coll Radiol 2017; 15:11-18. [PMID: 29079250 DOI: 10.1016/j.jacr.2017.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Our goal was to ascertain the quality of health information related to CT radiation exposure using a simulated Internet search and from incident information that may be available during day-to-day Internet usage. METHODS We entered 14 terms relating to information on CT dose into the most commonly used Internet search engine and analyzed the first 100 web page results for each. A Rich Search Site (RSS) feed search was also used to evaluate incidental information over a 12-week period in 2014. Each web page was classified as being "completely accurate," "somewhat accurate," or "inaccurate." RESULTS Of 1,400 web pages, 290 were relevant and accessible. We deemed 12.8% of these pages as inaccurate and 67.2% of pages as completely accurate. The highest proportion of web pages was from media sources, which, along with discussion forums, commercial websites, and blogs, were found to have proportionally the largest amount of inaccurate information. Of 1,943 posts, 136 (7.0%) identified by the RSS were relevant, 9.6% were deemed inaccurate, and only 29.9% were deemed completely accurate. The results of our simulated query highlight the importance of public education regarding Internet usage when researching topics relating to radiation exposure associated with CT.
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Affiliation(s)
- Siobhán O'Neill
- Cork University Hospital, Bishopstown Road, Wilton, Cork, Ireland
| | - David Glynn
- Cork University Hospital, Bishopstown Road, Wilton, Cork, Ireland
| | - Kevin P Murphy
- Cork University Hospital, Bishopstown Road, Wilton, Cork, Ireland
| | - Karl James
- Cork University Hospital, Bishopstown Road, Wilton, Cork, Ireland.
| | - Maria Twomey
- Cork University Hospital, Bishopstown Road, Wilton, Cork, Ireland
| | - Richard Kavanagh
- Cork University Hospital, Bishopstown Road, Wilton, Cork, Ireland
| | - Owen J O'Connor
- Cork University Hospital, Bishopstown Road, Wilton, Cork, Ireland
| | - Michael M Maher
- Cork University Hospital, Bishopstown Road, Wilton, Cork, Ireland
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23
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Ronan NJ, Einarsson GG, Twomey M, Mooney D, Mullane D, NiChroinin M, O'Callaghan G, Shanahan F, Murphy DM, O'Connor OJ, Shortt CA, Tunney MM, Eustace JA, Maher MM, Elborn JS, Plant BJ. CORK Study in Cystic Fibrosis: Sustained Improvements in Ultra-Low-Dose Chest CT Scores After CFTR Modulation With Ivacaftor. Chest 2017; 153:395-403. [PMID: 29037527 DOI: 10.1016/j.chest.2017.10.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 09/16/2017] [Accepted: 10/02/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Ivacaftor produces significant clinical benefit in patients with cystic fibrosis (CF) with the G551D mutation. Prevalence of this mutation at the Cork CF Centre is 23%. This study assessed the impact of cystic fibrosis transmembrane conductance regulator modulation on multiple modalities of patient assessment. METHODS Thirty-three patients with the G551D mutation were assessed at baseline and prospectively every 3 months for 1 year after initiation of ivacaftor. Change in ultra-low-dose chest CT scans, blood inflammatory mediators, and the sputum microbiome were assessed. RESULTS Significant improvements in FEV1, BMI, and sweat chloride levels were observed post-ivacaftor treatment. Improvement in ultra-low-dose CT imaging scores were observed after treatment, with significant mean reductions in total Bhalla score (P < .01), peribronchial thickening (P = .035), and extent of mucous plugging (P < .001). Reductions in circulating inflammatory markers, including interleukin (IL)-1β, IL-6, and IL-8 were demonstrated. There was a 30% reduction in the relative abundance of Pseudomonas species and an increase in the relative abundance of bacteria associated with more stable community structures. Posttreatment community richness increased significantly (P = .03). CONCLUSIONS Early and sustained improvements on ultra-low-dose CT scores suggest it may be a useful method of evaluating treatment response. It paralleled improvement in symptoms, circulating inflammatory markers, and changes in the lung microbiota.
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Affiliation(s)
- Nicola J Ronan
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | - Gisli G Einarsson
- CF & Airways Microbiology Research Group, Queen's University Belfast, Belfast, Northern Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Denver Mooney
- CF & Airways Microbiology Research Group, Queen's University Belfast, Belfast, Northern Ireland
| | - David Mullane
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland
| | - Muireann NiChroinin
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland
| | - Grace O'Callaghan
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | | | - Desmond M Murphy
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Cathy A Shortt
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland
| | - Michael M Tunney
- CF & Airways Microbiology Research Group, Queen's University Belfast, Belfast, Northern Ireland
| | - Joseph A Eustace
- HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - J Stuart Elborn
- CF & Airways Microbiology Research Group, Queen's University Belfast, Belfast, Northern Ireland; Imperial College and Royal Brompton Hospital, London, England
| | - Barry J Plant
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland.
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24
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Murphy KP, McLaughlin PD, Twomey M, Chan VE, Moloney F, Fung AJ, Chan FE, Kao T, O'Neill SB, Watson B, O'Connor OJ, Maher MM. Accurate tissue characterization in low-dose CT imaging with pure iterative reconstruction. J Med Imaging Radiat Oncol 2016; 61:190-196. [PMID: 27739229 DOI: 10.1111/1754-9485.12546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 09/09/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We assess the ability of low-dose hybrid iterative reconstruction (IR) and 'pure' model-based IR (MBIR) images to maintain accurate Hounsfield unit (HU)-determined tissue characterization. METHODS Standard-protocol (SP) and low-dose modified-protocol (MP) CTs were contemporaneously acquired in 34 Crohn's disease patients referred for CT. SP image reconstruction was via the manufacturer's recommendations (60% FBP, filtered back projection; 40% ASiR, Adaptive Statistical iterative Reconstruction; SP-ASiR40). MP data sets underwent four reconstructions (100% FBP; 40% ASiR; 70% ASiR; MBIR). Three observers measured tissue volumes using HU thresholds for fat, soft tissue and bone/contrast on each data set. Analysis was via SPSS. RESULTS Inter-observer agreement was strong for 1530 datapoints (rs > 0.9). MP-MBIR tissue volume measurement was superior to other MP reconstructions and closely correlated with the reference SP-ASiR40 images for all tissue types. MP-MBIR superiority was most marked for fat volume calculation - close SP-ASiR40 and MP-MBIR Bland-Altman plot correlation was seen with the lowest average difference (336 cm3 ) when compared with other MP reconstructions. CONCLUSIONS Hounsfield unit-determined tissue volume calculations from MP-MBIR images resulted in values comparable to SP-ASiR40 calculations and values that are superior to MP-ASiR images. Accuracy of estimation of volume of tissues (e.g. fat) using segmentation software on low-dose CT images appears optimal when reconstructed with pure IR.
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Affiliation(s)
- Kevin P Murphy
- Department of Radiology, University College Cork, Cork, Ireland
| | | | - Maria Twomey
- Department of Radiology, University College Cork, Cork, Ireland
| | - Vincent E Chan
- Department of Radiology, University College Cork, Cork, Ireland
| | - Fiachra Moloney
- Department of Radiology, University College Cork, Cork, Ireland
| | - Adrian J Fung
- Department of Radiology, University College Cork, Cork, Ireland
| | - Faimee E Chan
- Department of Radiology, University College Cork, Cork, Ireland
| | - Tafline Kao
- Department of Radiology, University College Cork, Cork, Ireland
| | | | - Benjamin Watson
- Department of Radiology, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, University College Cork, Cork, Ireland
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25
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Murphy KP, Crush L, O'Malley E, Daly FE, Twomey M, O'Tuathaigh CMP, Maher MM, Cryan JF, O'Connor OJ. Medical student perceptions of radiology use in anatomy teaching. Anat Sci Educ 2015; 8:510-7. [PMID: 25516061 DOI: 10.1002/ase.1502] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 09/17/2014] [Accepted: 10/08/2014] [Indexed: 05/16/2023]
Abstract
The use of radiology in the teaching of anatomy to medical students is gaining in popularity; however, there is wide variation in how and when radiology is introduced into the curriculum. The authors sought to investigate students' perceptions regarding methods used to depict and teach anatomy and effects of integrated radiology instruction on students' abilities to correctly identify imaging modalities and anatomical structures on radiological images. First-year medical students completed questionnaires at the beginning and end of the first academic year that incorporated ten hours of radiologic anatomy teaching in the anatomy curriculum. Questions used a combination of Likert scales, rankings, and binary options. Students were tested on their ability to identify radiology modalities and anatomical structures on radiology images. Preresponse and postresponse rates were 93% (157/168) and 85% (136/160), respectively. Postmodule, 96.3% of students wanted the same or more radiology integration. Furthermore, 92.4% premodule and 96.2% postmodule agreed that "Radiology is important in medical undergraduate teaching." Modality and structure identification scores significantly increased from 59.8% to 64.3% (P < 0.001) and from 47.4% to 71.2% (P < 0.001), respectively. The top three preferred teaching formats premodule and postmodule were (1) anatomy laboratory instruction, (2) interactive sessions combining radiology with anatomy, and (3) anatomy lectures. Postmodule, 38.3% of students were comfortable reviewing radiology images. Students were positive about integrating radiology into anatomy teaching and most students wanted at least the same level of assimilation but that it is used as an adjunct rather than primary method of teaching anatomy.
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Affiliation(s)
- Kevin P Murphy
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
| | - Lee Crush
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
| | - Eoin O'Malley
- Department of Radiology, University College Cork, Cork, Ireland
| | - Fergus E Daly
- Department of Radiology, University College Cork, Cork, Ireland
| | - Maria Twomey
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
| | | | - Michael M Maher
- Department of Radiology, University College Cork, Cork, Ireland
| | - John F Cryan
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland
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26
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Murphy KP, Crush L, McLaughlin PD, O'Sullivan HS, Twomey M, Lynch S, Bye J, McSweeney SE, O'Connor OJ, Shanahan F, Maher MM. The role of pure iterative reconstruction in conventional dose CT enterography. ACTA ACUST UNITED AC 2015; 40:251-7. [PMID: 25139642 DOI: 10.1007/s00261-014-0222-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Pure iterative reconstruction (Pure IR) has been proposed as a solution to improve diagnostic quality of low dose CT images. We assess the performance of model based iterative reconstruction (MBIR) in improving conventional dose CT enterography (CTE) images. METHODS 43 Crohn's patients (27 female) (38.5 ± 12.98 years) referred for CTE were included. Images were reconstructed with pure IR (MBIR, General Electric Healthcare) in addition to standard department protocol (reconstructed with hybrid iterative reconstruction (Hybrid IR) [60% filtered back projection/40% adaptive statistical IR (General Electric Healthcare)]. Image quality was assessed objectively and subjectively at 6 anatomical levels. Clinical interpretation was undertaken in consensus by 2 blinded radiologists along with 2 non-blinded readers ('gold standard'). Results were analyzed using Statistical Package for Social Scientists. RESULTS Mean effective radiation dose was 6.05 ± 2.84 mSv (size specific dose estimates 9.25 ± 2.9 mGy). Objective and subjective assessment yielded 6106 data points. Pure IR images significantly outperformed those using standard reconstruction techniques across all subjective (p < 0.001 for all comparisons) (noise, contrast resolution, spatial resolution, streak artifact, axial diagnostic acceptability, coronal diagnostic acceptability) and objective (p < 0.004) (noise, signal-to-noise ratio) parameters. Clinical reads of the pure IR images agreed more closely with the gold standard reads than the hybrid IR image reads in terms of overall Crohn's activity grade (κ = 0.630, 0.308) and detection of acute complications (κ = 1.0, 0.896). Results were comparable for bowel wall disease severity assessment (κ = 0.523, 0.593). CONCLUSIONS Pure IR considerably improves image quality of conventional dose CTE images and therefore its use should be expanded beyond low dose protocols to improving image quality at conventional dose CT imaging.
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Affiliation(s)
- Kevin P Murphy
- Department of Radiology, University College Cork, Cork, Ireland
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27
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Nardelli P, Khan KA, Corvò A, Moore N, Murphy MJ, Twomey M, O'Connor OJ, Kennedy MP, Estépar RSJ, Maher MM, Cantillon-Murphy P. Optimizing parameters of an open-source airway segmentation algorithm using different CT images. Biomed Eng Online 2015; 14:62. [PMID: 26112975 PMCID: PMC4482101 DOI: 10.1186/s12938-015-0060-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computed tomography (CT) helps physicians locate and diagnose pathological conditions. In some conditions, having an airway segmentation method which facilitates reconstruction of the airway from chest CT images can help hugely in the assessment of lung diseases. Many efforts have been made to develop airway segmentation algorithms, but methods are usually not optimized to be reliable across different CT scan parameters. METHODS In this paper, we present a simple and reliable semi-automatic algorithm which can segment tracheal and bronchial anatomy using the open-source 3D Slicer platform. The method is based on a region growing approach where trachea, right and left bronchi are cropped and segmented independently using three different thresholds. The algorithm and its parameters have been optimized to be efficient across different CT scan acquisition parameters. The performance of the proposed method has been evaluated on EXACT'09 cases and local clinical cases as well as on a breathing pig lung phantom using multiple scans and changing parameters. In particular, to investigate multiple scan parameters reconstruction kernel, radiation dose and slice thickness have been considered. Volume, branch count, branch length and leakage presence have been evaluated. A new method for leakage evaluation has been developed and correlation between segmentation metrics and CT acquisition parameters has been considered. RESULTS All the considered cases have been segmented successfully with good results in terms of leakage presence. Results on clinical data are comparable to other teams' methods, as obtained by evaluation against the EXACT09 challenge, whereas results obtained from the phantom prove the reliability of the method across multiple CT platforms and acquisition parameters. As expected, slice thickness is the parameter affecting the results the most, whereas reconstruction kernel and radiation dose seem not to particularly affect airway segmentation. CONCLUSION The system represents the first open-source airway segmentation platform. The quantitative evaluation approach presented represents the first repeatable system evaluation tool for like-for-like comparison between different airway segmentation platforms. Results suggest that the algorithm can be considered stable across multiple CT platforms and acquisition parameters and can be considered as a starting point for the development of a complete airway segmentation algorithm.
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Affiliation(s)
- Pietro Nardelli
- School of Engineering , University College Cork, College Road, Cork, Ireland.
| | - Kashif A Khan
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland.
| | - Alberto Corvò
- School of Engineering , University College Cork, College Road, Cork, Ireland.
| | - Niamh Moore
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
| | - Mary J Murphy
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
| | - Marcus P Kennedy
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland.
| | - Raúl San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
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Sullivan CJ, Murphy KP, McLaughlin PD, Twomey M, O'Regan KN, Power DG, Maher MM, O'Connor OJ. Radiation exposure from diagnostic imaging in young patients with testicular cancer. Eur Radiol 2014; 25:1005-13. [PMID: 25500962 DOI: 10.1007/s00330-014-3507-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/30/2014] [Accepted: 11/13/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Risks associated with high cumulative effective dose (CED) from radiation are greater when imaging is performed on younger patients. Testicular cancer affects young patients and has a good prognosis. Regular imaging is standard for follow-up. This study quantifies CED from diagnostic imaging in these patients. METHODS Radiological imaging of patients aged 18-39 years, diagnosed with testicular cancer between 2001 and 2011 in two tertiary care centres was examined. Age at diagnosis, cancer type, dose-length product (DLP), imaging type, and frequency were recorded. CED was calculated from DLP using conversion factors. Statistical analysis was performed with SPSS. RESULTS In total, 120 patients with a mean age of 30.7 ± 5.2 years at diagnosis had 1,410 radiological investigations. Median (IQR) surveillance was 4.37 years (2.0-5.5). Median (IQR) CED was 125.1 mSv (81.3-177.5). Computed tomography accounted for 65.3 % of imaging studies and 98.3 % of CED. We found that 77.5 % (93/120) of patients received high CED (>75 mSv). Surveillance time was associated with high CED (OR 2.1, CI 1.5-2.8). CONCLUSIONS Survivors of testicular cancer frequently receive high CED from diagnostic imaging, mainly CT. Dose management software for accurate real-time monitoring of CED and low-dose CT protocols with maintained image quality should be used by specialist centres for surveillance imaging. KEY POINTS • CT accounted for 98.3 % of CED in patients with testicular cancer. • Median CED in patients with testicular cancer was 125.1 mSv • High CED (>75 mSv) was observed in 77.5 % (93/120) of patients. • Dose tracking and development of low-dose CT protocols are recommended.
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Affiliation(s)
- C J Sullivan
- Department of Radiology, Cork and Mercy University Hospitals, Wilton, Cork, Ireland
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29
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Murphy KP, Crush L, O'Malley E, Daly FE, O'Tuathaigh CMP, O'Connor OJ, Cryan JF, Maher MM. Medical student knowledge regarding radiology before and after a radiological anatomy module: implications for vertical integration and self-directed learning. Insights Imaging 2014; 5:629-34. [PMID: 25107581 PMCID: PMC4195841 DOI: 10.1007/s13244-014-0346-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/06/2014] [Accepted: 07/03/2014] [Indexed: 11/25/2022] Open
Abstract
Objectives To examine the impact that anatomy-focused radiology teaching has on non-examined knowledge regarding radiation safety and radiology as a specialty. Methods First-year undergraduate medical students completed surveys prior to and after undertaking the first-year anatomy programme that incorporates radiological anatomy. Students were asked opinions on preferred learning methodology and tested on understanding of radiology as a specialty and radiation safety. Results Pre-module and post-module response rates were 93 % (157/168) and 85 % (136/160), respectively. Pre-module and post-module, self-directed learning (SDL) ranked eighth (of 11) for preferred gross-anatomy teaching formats. Correct responses regarding radiologist/radiographer roles varied from 28-94 % on 16 questions with 4/16 significantly improving post-module. Identification of modalities that utilise radiation significantly improved for five of eight modalities post-module but knowledge regarding relative amount of modality-specific radiation use was variable pre-module and post-module. Conclusions SDL is not favoured as an anatomy teaching method. Exposure of students to a radiological anatomy module delivered by senior clinical radiologists improved basic knowledge regarding ionising radiation use, but there was no improvement in knowledge regarding radiation exposure relative per modality. A possible explanation is that students recall knowledge imparted in didactic lectures but do little reading around the subject when the content is not examined. Teaching Points • Self-directed learning is not favoured as a gross anatomy teaching format amongst medical students. • An imaging anatomy-focused module improved basic knowledge regarding ionising radiation use. • Detailed knowledge of modality-specific radiation exposure remained suboptimal post-module. • Knowledge of roles within a clinical radiology department showed little change post-module.
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Affiliation(s)
- Kevin P Murphy
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
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Moloney F, Murphy KP, Twomey M, O'Connor OJ, Maher MM. Haematuria: an imaging guide. Adv Urol 2014; 2014:414125. [PMID: 25136357 PMCID: PMC4124848 DOI: 10.1155/2014/414125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 11/23/2022] Open
Abstract
This paper discusses the current status of imaging in the investigation of patients with haematuria. The physician must rationalize imaging so that serious causes such as malignancy are promptly diagnosed while at the same time not exposing patients to unnecessary investigations. There is currently no universal agreement about the optimal imaging work up of haematuria. The choice of modality to image the urinary tract will depend on individual patient factors such as age, the presence of risk factors for malignancy, renal function, a history of calculus disease and pregnancy, and other factors, such as local policy and practice, cost effectiveness and availability of resources. The role of all modalities, including conventional radiography, intravenous urography/excretory urography, ultrasonography, retrograde pyelography, multidetector computed tomography urography (MDCTU), and magnetic resonance urography, is discussed. This paper highlights the pivotal role of MDCTU in the imaging of the patient with haematuria and discusses issues specific to this modality including protocol design, imaging of the urothelium, and radiation dose. Examination protocols should be tailored to the patient while all the while optimizing radiation dose.
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Affiliation(s)
- Fiachra Moloney
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Kevin P. Murphy
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Owen J. O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael M. Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
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O'Connor OJ, Diver E, McDermott S, Covarrubias DA, Shelly MJ, Growdon W, Hahn PF, Mueller PR. Palliative Gastrostomy in the Setting of Voluminous Ascites. J Palliat Med 2014; 17:811-21. [DOI: 10.1089/jpm.2013.0397] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Owen J. O'Connor
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth Diver
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shaunagh McDermott
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Martin J. Shelly
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Whitfield Growdon
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter F. Hahn
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter R. Mueller
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Abstract
Percutaneous splenic biopsy and drainage are relatively safe and accurate procedures. The risk of major complication (1.3%) following percutaneous splenic biopsy does not exceed that of other solid intra-abdominal organ biopsies, and it has less morbidity and mortality than splenectomy. Both computed tomography and ultrasound can be used to provide image guidance for biopsy and drainage. The safety profile of fine-needle aspiration cytology is better than core needle biopsy, but core biopsy has superior diagnostic accuracy.
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Affiliation(s)
- Jennifer Sammon
- Department of Radiology, Cork University Hospital and University College Cork, Wilton, Cork, Ireland
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O'Neill SB, Mc Laughlin PD, Crush L, O'Connor OJ, Mc Williams SR, Craig O, Mc Garrigle AM, O'Neill F, Bye J, Ryan MF, Shanahan F, Maher MM. A prospective feasibility study of sub-millisievert abdominopelvic CT using iterative reconstruction in Crohn's disease. Eur Radiol 2013; 23:2503-12. [PMID: 23740025 DOI: 10.1007/s00330-013-2858-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/03/2013] [Accepted: 03/17/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Iterative reconstruction (IR) allows diagnostic CT imaging with less radiation exposure than filtered back projection (FBP). We studied an IR low-dose CT abdomen/pelvis (LDCTAP) protocol, designed to image at an effective dose (ED) approximating 1 mSv in patients with Crohn's disease (CD). METHODS Forty patients, mean age 37 ± 13.4 years (range 17-69), with CD underwent two synchronous CT protocols (conventional-dose (CDCTAP) and LDCTAP). CDCTAP and LDCTAP images were compared for diagnostic acceptability, yield, image quality and ED (in millisieverts). The optimal level of IR for LDCTAP was also studied. RESULTS LDCTAP yielded a mean ED of 1.3 ± 0.8 mSv compared with 4.7 ± 2.9 mSv for CDCTAP, reducing ED by 73.7 ± 3.3 % (mean dose reduction, 3.5 ± 2.1 mSv; P < 0.001) and dose length product by 73.6 ± 2.6 % (P < 0.001). Sub-millisievert (0.84 mSv) imaging was performed for patients with a body mass index (BMI) less than 25 (i.e. 63 % of our cohort). LDCTAP resulted in increased image noise and reduced diagnostic acceptability compared with CDCTAP despite use of IR, but detection of extra-luminal complications was comparable. CONCLUSION Patients with suspected active CD can be adequately imaged using LDCTAP, yielding comparable information regarding extent, activity and complications of CD compared with CDCTAP, but with 74 % less dose. LDCTAP at doses equivalent to that of two abdominal radiographs represents a feasible alternative to CDCTAP. KEY POINTS • Radiation dose is a concern when imaging patients with Crohn's disease. • New techniques allow low-dose abdominopelvic CT with acceptable image quality. • Using hybrid iterative reconstruction, its diagnostic yield compares well with that of conventional CT. • Sub-millisievert CT of patients with Crohn's disease appears technically and clinically feasible.
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Affiliation(s)
- Siobhan B O'Neill
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
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Mc Williams SR, Mc Laughlin PD, O'Connor OJ, Desmond AN, Ní Laoíre A, Shanahan F, Quigley EM, Maher MM. Computed tomography assessment of intestinal gas volumes in functional gastrointestinal disorders. J Neurogastroenterol Motil 2012; 18:419-25. [PMID: 23106003 PMCID: PMC3479256 DOI: 10.5056/jnm.2012.18.4.419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 08/13/2012] [Accepted: 08/22/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/AIMS Many patients with functional gastrointestinal disorders (FGIDs) rank sensations of bloating and distension among their most debilitating symptoms. Previous studies that have examined intestinal gas volume (IGV) in patients with FGIDs have employed a variety of invasive and imaging techniques. These studies are limited by small numbers and have shown conflicting results. The aim of our study was to estimate, using CT of the abdomen and pelvis (CTAP), IGV in patients attending FGID clinic and to compare IGV in patients with and without FGID. METHODS All CTAP (n = 312) performed on patients (n = 207) attending a specialized FGID clinic over 10-year period were included in this study. Patients were classified into one of 3 groups according to the established clinical grading system, as organic gastrointestinal disorder (OGID, ie, patients with an organic non-functional disorder, n = 84), FGID (n = 36) or organic and functional gastrointestinal disorder (OFGID, ie, patients with an organic and a functional disorder, n = 87). Two independent readers blinded to the diagnostic group calculated IGV using threshold based 3D region growing with OsiriX. RESULTS Median IGVs for the FGID, OGID, and OFGID groups were 197.6, 220.6 and 155.0 mL, respectively. Stepwise linear regression revealed age at study, gender, and calculated body mass index to predict the log IGV with an r(2) of 0.116, and P < 0.001. There was a significant positive correlation between age and IGV in OGID (Spearman's = 0.253, P = 0.02) but this correlation was non-significant in the other groups. CONCLUSIONS Although bloating is a classic symptom in FGID patients, IGV may not be increased compared with OGID and OFGID patients.
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Affiliation(s)
- Sebastian R Mc Williams
- Department of Radiology, University College Cork and Cork University Hospital, Cork, Ireland
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O'Connell OJ, McGarrigle A, O'Connor OJ, Maher MM, Plant BJ. Radiation Dose for Pediatric Patients With Cystic Fibrosis: Response. Chest 2012. [DOI: 10.1378/chest.12-1720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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O'Regan K, O'Connor OJ, O'Neill SB, Mc Laughlin PD, Desmond A, McWilliams SR, Quigley EMM, Shanahan F, Maher MM. Plain abdominal radiographs in patients with Crohn's disease: radiological findings and diagnostic value. Clin Radiol 2012; 67:774-81. [PMID: 22749384 DOI: 10.1016/j.crad.2012.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 12/09/2011] [Accepted: 01/09/2012] [Indexed: 11/18/2022]
Abstract
AIM To determine the diagnostic yield and clinical value of plain film of the abdomen (PFA) in Crohn's disease (CD) patients and to determine whether performance of PFA yields definitive diagnostic information or whether additional imaging examinations are required. MATERIALS AND METHODS One hundred and seventy-seven CD patients underwent 643 PFAs during the period September 1992 to August 2008. Two radiologists blinded to the clinical details independently evaluated individual PFAs and/or their reports for abnormal findings using the following criteria: normal, small bowel (SB) findings; colonic findings, acute CD complications, extra-colonic findings; global assessment/impression. The results of additional imaging studies performed within 5 days of PFA were recorded and findings were analysed. RESULTS A mean of 3.6 (range 1-22) PFAs was performed per patient during the study period. Almost 70% of films were normal (n = 449). SB abnormalities were detected in 21.8% (n = 140) PFAs; most commonly dilated loops (18.8%, n = 121) and mucosal oedema (5%, n = 32). Colonic abnormalities were present in 11.4% (n = 73); most commonly mucosal oedema (7.5%, n = 48) and dilated loops (5%, n = 32). Four cases of pneumoperitoneum were detected. There was no case of toxic megacolon. There was one case in which intra-abdominal abscess/collection was suspected and two cases of obstruction/ileus. Extracolonic findings (renal calculi, sacro-iliitis, etc.) were identified in 7.5% (n = 48). PFAs were followed by additional abdominal imaging within 5 days of PFA in 273/643 (42.5%) of cases. CONCLUSION Despite the high rates of utilization of PFA in CD patients, there is a low incidence of abnormal findings (32.5%). Many of the findings are non-specific and clinically irrelevant and PFA is frequently followed by additional abdominal imaging examinations.
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Affiliation(s)
- K O'Regan
- Department of Radiology, Cork University Hospital and University College Cork, Cork, Ireland
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Neary PM, O'Connor OJ, Shafiq A, Quinn EM, Kelly JJ, Juliette B, Cahill RA, Barry J, Redmond HP. The impact of routine open nonsuction drainage on fluid accumulation after thyroid surgery: a prospective randomised clinical trial. World J Surg Oncol 2012; 10:72. [PMID: 22540955 PMCID: PMC3407716 DOI: 10.1186/1477-7819-10-72] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 04/28/2012] [Indexed: 11/10/2022] Open
Abstract
Background Thyroid drains following thyroid surgery are routinely used despite minimal supportive evidence. Our aim in this study is to determine the impact of routine open drainage of the thyroid bed postoperatively on ultrasound-determined fluid accumulation at 24 hours. Methods We conducted a prospective randomised clinical trial on patients undergoing thyroid surgery. Patients were randomly assigned to a drain group (n = 49) or a no-drain group (n = 44) immediately prior to wound closure. Patients underwent a neck ultrasound on day 1 and day 2 postoperatively. After surgery, we evaluated visual analogue scale pain scores, postoperative analgesic requirements, self-reported scar satisfaction at 6 weeks and complications. Results There was significantly less mean fluid accumulated in the drain group on both day 1, 16.4 versus 25.1 ml (P-value = 0.005), and day 2, 18.4 versus 25.7 ml (P-value = 0.026), following surgery. We found no significant differences between the groups with regard to length of stay, scar satisfaction, visual analogue scale pain score and analgesic requirements. There were four versus one wound infections in the drain versus no-drain groups. This finding was not statistically significant (P = 0.154). No life-threatening bleeds occurred in either group. Conclusions Fluid accumulation after thyroid surgery was significantly lessened by drainage. However, this study did not show any clinical benefit associated with this finding in the nonemergent setting. Drains themselves showed a trend indicating that they may augment infection rates. The results of this study suggest that the frequency of acute life-threatening bleeds remains extremely low following abandoning drains. We advocate abandoning routine use of thyroid drains. Trial registration ISRCTN94715414
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Affiliation(s)
- Peter M Neary
- Department of Academic Surgery, Cork University Hospital, University College Cork, Cork, Ireland.
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McWilliams SR, O'Connor OJ, McGarrigle AM, O'Neill SB, Quigley EMM, Shanahan F, Maher MM. CT-based estimation of intracavitary gas volumes using threshold-based segmentation: in vitro study to determine the optimal threshold range. J Med Imaging Radiat Oncol 2012; 56:289-94. [PMID: 22697325 DOI: 10.1111/j.1754-9485.2012.02375.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study investigated the optimal Hounsfield unit (HU) threshold range when using threshold-based segmentation to estimate volumes of contained gas (i.e. intestinal gas) on CT. METHODS A water-filled cylindrical acrylic imaging phantom containing two saline bags modified to allow injection of known volumes of gas (room air) was constructed. The phantom was imaged with CT following injection of known gas volumes. Images were analysed using standard threshold-based 3D region growing with human-entered seed points. The lower threshold was -1024 HU, and upper thresholds between -700 HU and -200 HU were tested for each volume. Appropriate statistical analysis was performed. RESULTS Measurements were normally distributed. There was excellent correlation between measured and injected volumes for all thresholds (Pearson's r > 0.99). The optimal upper threshold for small gas volumes (1-6 mL) was -550 HU with 0.1% ± 3.9% (mean ± standard deviation) error. The optimal upper threshold for large gas volumes (10-50 mL) was -350 HU with 0.7 ± 3.6% (mean ± standard deviation) error with Pearson correlations of r > 0.99 for both. CONCLUSION Accurate estimation of gas volumes on CT is possible using threshold-based segmentation software with a wide range of upper thresholds. The optimal upper threshold for estimation of small volumes (1-6 mL) was -550 HU and -350 HU for volumes of 10-50 mL.
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Mc Laughlin PD, O'Connor OJ, O'Neill SB, Shanahan F, Maher MM. Minimization of Radiation Exposure due to Computed Tomography in Inflammatory Bowel Disease. ISRN Gastroenterol 2012; 2012:790279. [PMID: 22577571 PMCID: PMC3332204 DOI: 10.5402/2012/790279] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 01/29/2012] [Indexed: 01/13/2023]
Abstract
Patient awareness and concern regarding the potential health risks from ionizing radiation have peaked recently (Coakley et al., 2011) following widespread press and media coverage of the projected cancer risks from the increasing use of computed tomography (CT) (Berrington et al., 2007). The typical young and educated patient with inflammatory bowel disease (IBD) may in particular be conscious of his/her exposure to ionising radiation as a result of diagnostic imaging. Cumulative effective doses (CEDs) in patients with IBD have been reported as being high and are rising, primarily due to the more widespread and repeated use of CT (Desmond et al., 2008). Radiologists, technologists, and referring physicians have a responsibility to firstly counsel their patients accurately regarding the actual risks of ionizing radiation exposure; secondly to limit the use of those imaging modalities which involve ionising radiation to clinical situations where they are likely to change management; thirdly to ensure that a diagnostic quality imaging examination is acquired with lowest possible radiation exposure. In this paper, we synopsize available evidence related to radiation exposure and risk and we report advances in low-dose CT technology and examine the role for alternative imaging modalities such as ultrasonography or magnetic resonance imaging which avoid radiation exposure.
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O'Connor OJ, Buckley JM, Arellano RS. Doctor, would you drain this collection? J Vasc Interv Radiol 2012; 23:519. [PMID: 22464716 DOI: 10.1016/j.jvir.2012.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 01/03/2012] [Accepted: 01/04/2012] [Indexed: 10/28/2022] Open
Affiliation(s)
- Owen J O'Connor
- Department of Radiology, Massachusetts General Hospital, White 270, 55 Fruit St., Boston, MA 02114, USA.
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Shelly MJ, McDermott S, O'Connor OJ, Blake MA. 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Management of Aggressive Non-Hodgkin's B-Cell Lymphoma. ISRN Hematol 2012; 2012:456706. [PMID: 22474590 PMCID: PMC3313577 DOI: 10.5402/2012/456706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 12/29/2011] [Indexed: 12/13/2022]
Abstract
18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma. The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone. The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.
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Affiliation(s)
- M J Shelly
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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Leong S, Mc Laughlin P, O'Connor OJ, O'Flynn S, Maher MM. An Assessment of the Feasibility and Effectiveness of an E-Learning Module in Delivering a Curriculum in Radiation Protection to Undergraduate Medical Students. J Am Coll Radiol 2012; 9:203-9. [DOI: 10.1016/j.jacr.2011.09.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 09/20/2011] [Indexed: 10/28/2022]
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Abstract
Incidental adrenal lesions are very common. Computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) all have a role to play in characterizing adrenal lesions. The purpose of this review is to discuss the rationale behind both established and emerging imaging techniques. We also discuss how to follow up incidentally found lesions.
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Affiliation(s)
- S McDermott
- Department of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
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O'Connell OJ, McWilliams S, McGarrigle A, O'Connor OJ, Shanahan F, Mullane D, Eustace J, Maher MM, Plant BJ. Radiologic imaging in cystic fibrosis: cumulative effective dose and changing trends over 2 decades. Chest 2011; 141:1575-1583. [PMID: 22207674 DOI: 10.1378/chest.11-1972] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE With the increasing life expectancy for patients with cystic fibrosis (CF), and a known predisposition to certain cancers, cumulative radiation exposure from radiologic imaging is of increasing significance. This study explores the estimated cumulative effective radiation dose over a 17-year period from radiologic procedures and changing trends of imaging modalities over this period. METHODS Estimated cumulative effective dose (CED) from all thoracic and extrathoracic imaging modalities and interventional radiology procedures for both adult and pediatric patients with CF, exclusively attending a nationally designated CF center between 1992-2009 for > 1 year, was determined. The study period was divided into three equal tertiles, and estimated CED attributable to all radiologic procedures was estimated for each tertile. RESULTS Two hundred thirty patients met inclusion criteria (2,240 person-years of follow-up; 5,596 radiologic procedures). CED was > 75 mSv for one patient (0.43%), 36 patients (15.6%) had a CED between 20 and 75 mSv, 56 patients (24.3%) had a CED between 5 and 20 mSv, and in 138 patients (60%) the CED was estimated to be between 0 and 5 mSv over the study period. The mean annual CED per patient increased consecutively from 0.39 mSv/y to 0.47 mSv/y to 1.67 mSv/y over the tertiles one to three of the study period, respectively (P < .001). Thoracic imaging accounted for 46.9% of the total CED and abdominopelvic imaging accounted for 42.9% of the CED, respectively. There was an associated 5.9-fold increase in the use of all CT scanning per patient (P < .001). CONCLUSIONS This study highlights the increasing exposure to ionizing radiation to patients with CF as a result of diagnostic imaging, primarily attributable to CT scanning. Increased awareness of CED and strategies to reduce this exposure are needed.
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Affiliation(s)
- Oisin J O'Connell
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland
| | - Sebastian McWilliams
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland
| | - AnneMarie McGarrigle
- Department of Radiation Physics, Cork University Hospital, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Fergus Shanahan
- Department of Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - David Mullane
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland
| | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Barry J Plant
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland.
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O'Connor OJ, McDermott S, Slattery J, Sahani D, Blake MA. The Use of PET-CT in the Assessment of Patients with Colorectal Carcinoma. Int J Surg Oncol 2011; 2011:846512. [PMID: 22312527 PMCID: PMC3263658 DOI: 10.1155/2011/846512] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 03/13/2011] [Accepted: 04/30/2011] [Indexed: 12/18/2022] Open
Abstract
Colorectal cancer is the third most commonly diagnosed cancer, accounting for 53,219 deaths in 2007 and an estimated 146,970 new cases in the USA during 2009. The combination of FDG PET and CT has proven to be of great benefit for the assessment of colorectal cancer. This is most evident in the detection of occult metastases, particularly intra- or extrahepatic sites of disease, that would preclude a curative procedure or in the detection of local recurrence. FDG PET is generally not used for the diagnosis of colorectal cancer although there are circumstances where PET-CT may make the initial diagnosis, particularly with its more widespread use. In addition, precancerous adenomatous polyps can also be detected incidentally on whole-body images performed for other indications; sensitivity increases with increasing polyp size. False-negative FDG PET findings have been reported with mucinous adenocarcinoma, and false-positive findings have been reported due to inflammatory conditions such as diverticulitis, colitis, and postoperative scarring. Therefore, detailed evaluation of the CT component of a PET/CT exam, including assessment of the entire colon, is essential.
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Affiliation(s)
- Owen J. O'Connor
- Abdominal Imaging & Intervention Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Shanaugh McDermott
- Abdominal Imaging & Intervention Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - James Slattery
- Abdominal Imaging & Intervention Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Dushyant Sahani
- Abdominal Imaging & Intervention Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Michael A. Blake
- Abdominal Imaging & Intervention Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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O'Donoghue K, O'Regan KN, Sheridan CP, O'Connor OJ, Benson J, McWilliams S, Moore N, Murphy MJ, Chopra R, Higgins JR, Maher MM. Investigation of the role of computed tomography as an adjunct to autopsy in the evaluation of stillbirth. Eur J Radiol 2011; 81:1667-75. [PMID: 21531519 DOI: 10.1016/j.ejrad.2011.03.093] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 03/24/2011] [Accepted: 03/30/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The number of parents agreeing to autopsy following stillbirth is declining, which has undermined clinicians' ability to assess causes of intrauterine death and can impact counselling regarding recurrence. Post-mortem radiological imaging is a potential alternative method of investigating perinatal loss. The aim of this study was to assess the role of multi-detector computed tomography (MDCT) in the investigation of stillbirth. STUDY DESIGN Following ethical approval and written consent, parents were offered MDCT of the stillborn infant. MDCT was performed with 3D reconstruction, and images were analysed for image quality, anthropomorphic measurements and pathologic findings. Body part and organ-specific measurements were performed; including head, chest and abdominal circumferences, and muscle and liver mass was also measured. Findings were correlated with obstetric history, post-mortem skeletal survey (plain radiography), and formal autopsy. RESULTS Fourteen third-trimester stillborn infants were scanned. Image quality was moderate to excellent for most body structures. CT was better than plain radiography for imaging skeletal structures and large solid organs and demonstrated a range of pathologies including renal vein thrombosis, mesenteric calcification and skeletal hyperostosis that were not seen on plain radiographs. MDCT did not overlook autopsy findings and provided some additional information. CONCLUSION This study confirms the feasibility of MDCT in the investigation of third trimester stillbirth. MDCT image quality is acceptable and the examination can demonstrate a range of anatomic and pathologic findings. Initially, its value may be as an important adjunct to conventional autopsy.
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Affiliation(s)
- Keelin O'Donoghue
- Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
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Brennan C, O'Connor OJ, O'Regan KN, Keohane C, Dineen J, Hinchion J, Sweeney B, Maher MM. Metastatic meningioma: positron emission tomography CT imaging findings. Br J Radiol 2011; 83:e259-62. [PMID: 21088084 DOI: 10.1259/bjr/11276652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The imaging findings of a case of metastasing meningioma are described. The case illustrates a number of rare and interesting features. The patient presented with haemoptysis 22 years after the initial resection of an intracranial meningioma. CT demonstrated heterogeneous masses with avid peripheral enhancement without central enhancement. Blood supply to the larger lesion was partially from small feeding vessels from the inferior pulmonary vein. These findings correlate with a previously published case in which there was avid uptake of fluoro-18-deoxyglucose peripherally with lesser uptake centrally. The diagnosis of metastasing meningioma was confirmed on percutaneous lung tissue biopsy.
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Affiliation(s)
- C Brennan
- Department of Radiology, Cork University Hospital and University College Cork, Cork, Ireland
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Affiliation(s)
- L Crush
- Department of Radiology, Cork University Hospital and University College Cork, National University of Ireland, Ireland
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O'Connor OJ, Vandeleur M, McGarrigle AM, Moore N, McWilliams SR, McSweeney SE, O'Neill M, Ni Chroinin M, Maher MM. Development of low-dose protocols for thin-section CT assessment of cystic fibrosis in pediatric patients. Radiology 2010; 257:820-9. [PMID: 20876388 DOI: 10.1148/radiol.10100278] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To develop low-dose thin-section computed tomographic (CT) protocols for assessment of cystic fibrosis (CF) in pediatric patients and determine the clinical usefulness thereof compared with chest radiography. MATERIALS AND METHODS After institutional review board approval and informed consent from patients or guardians were obtained, 14 patients with CF and 11 patients without CF (16 male, nine female; mean age, 12.6 years ± 5.4 [standard deviation]; range, 3.5-25 years) who underwent imaging for clinical reasons underwent low-dose thin-section CT. Sections 1 mm thick (protocol A) were used in 10 patients, and sections 0.5 mm thick (protocol B) were used in 15 patients at six levels at 120 kVp and 30-50 mA. Image quality and diagnostic acceptability were scored qualitatively and quantitatively by two radiologists who also quantified disease severity at thin-section CT and chest radiography. Effective doses were calculated by using a CT dosimetry calculator. RESULTS Low-dose thin-section CT was performed with mean effective doses of 0.19 mSv ± 0.03 for protocol A and 0.14 mSv ± 0.04 for protocol B (P < .005). Diagnostic acceptability and depiction of bronchovascular structures at lung window settings were graded as almost excellent for both protocols, but protocol B was inferior to protocol A for mediastinal assessment (P < .02). Patients with CF had moderate lung disease with a mean Bhalla score of 9.2 ± 5.3 (range, 0-19), compared with that of patients without CF (1.1 ± 1.4; P < .001). There was excellent correlation between thin-section CT and chest radiography (r = 0.88-0.92; P < .001). CONCLUSION Low-dose thin-section CT can be performed at lower effective doses than can standard CT, approaching those of chest radiography. Low-dose thin-section CT could be appropriate for evaluating bronchiectasis in pediatric patients, yielding appropriate information about lung parenchyma and bronchovascular structures.
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Affiliation(s)
- Owen J O'Connor
- Department of Radiology, University College Cork and Cork University Hospital, Wilton, Cork 1111, Ireland
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Sawbridge D, O'Connor OJ, MacEneaney P, Maher MM, Fitzgerald E. Successful Endovascular Treatment of an Infected External Iliac Pseudoaneurysm with Hemorrhage at Total Hip Arthroplasty. J Vasc Interv Radiol 2010; 21:1135-6. [DOI: 10.1016/j.jvir.2010.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 03/02/2010] [Accepted: 03/13/2010] [Indexed: 11/29/2022] Open
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